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Evaluation of pharmacy TECHnician supported MEDication administration rounds (TECHMED) on reducing omitted doses: a randomised controlled trial and process evaluation in a university teaching hospital

Richard Keers, The University of Manchester

BACKGROUND TO STUDY

Omitted medication doses are commonly seen in UK hospitals, and can be defined as the failure to administer a prescribed medication dose to a patient by the time the next dose is due. These omitted doses can and do lead to harm for patients, particularly if medicines involved are ‘critical’ in that they require regular administration to be effective, such as antibiotics and drugs to treat epilepsy.

AIM OF STUDY

The aim of this study is to find out whether introducing a pharmacy technician to support nurse drug administration rounds in a NHS teaching hospital can reduce the number of omitted doses when compared to wards where this technician support is not provided.

HOW STUDY WILL BE CARRIED OUT

Four medical and surgical wards will be randomly selected to receive pharmacy technician support whereas another four wards will be chosen for comparison that will not receive the technician. Salford Royal hospital uses electronic recording of prescribing and drug administration, and we will extract this data on the number of omitted doses and compare this to the number of doses that were due to be given to patients on the wards. Trained pharmacy technicians will visit the chosen wards on weekdays for two nurse drug administration rounds over 1 month to help them administer and document drug administration. We will then compare the proportion of omitted doses as well as dose omissions involving ‘critical’ medicines between the wards with technician support and those without to see if they are reduced. We will also spend time interviewing the pharmacy staff and nurses involved in the study to find out how well they thought the added support worked during their shifts and if they could suggest any improvements to support possible wider roll-out in the future.

HOW FINDINGS WILL BE USED

We intend to share the findings of our work with pharmacists, pharmacy technicians and other health care professionals at three conferences in the UK. We also plan to publish our work in respected journals in what is called ‘open access’ format, which means that members of the public as well as researchers and health care professionals can read it. Salford Royal may use this work to develop the role of their pharmacy technicians in the hospital, with the aim of improving service delivery whilst also reducing waste.

RELEVANCE TO PRACTICE AND PUBLIC BENEFIT

It is likely that millions of medication doses are omitted in UK hospitals each year and if this work can show some benefit in reducing these numbers then will be receiving improved care. This may reduce the length of time patients spend in hospital and the costs of treating them. This work may also help strengthen relationships between pharmacy and nursing staff in solving medication administration challenges, whilst also highlighting the best ways to develop pharmaceutical care services in the future to improve medicines management and reduce wastage.

This project ran from October 2015 to February 2017. The final report is available here.

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